Credit Application
Please print, fill out, and mail this form to: EE Schenck Company attn: Credit Department 6000 N Cutter Circle Portland, OR 97217
& Credit Card Information
Hold Initial Order for Terms
Y
N
INTERNAL USE ONLY Date:
Reviewed by:
Terms:
Sales Rep:
GENERAL BUSINESS INFORMATION: Business Name:
EE Schenck Customer #
Business Address: City/State/Zip:
Country:
Please fill out the following section to apply for CREDIT TERMS. To pay via CREDIT/DEBIT card, skip to the yellow CREDIT CARD section below.
APPLICATION FOR CREDIT TERMS
Please complete the following, sign and date to apply for Terms.
# of employees:
Starting capital:
Projected sales for 12 months:
Source of capital:
OWNERS, PARTNERS, OFFICERS, MEMBERS: Name:
Name:
Social Security #:
Social Security #:
Phone#:
Phone#:
CREDIT REFERENCES Include 4. Do not use factors or banks. Related industry preferred. Name:
Name:
Account #:
Account #:
Email/Fax#:
Email/Fax#:
Name:
Name:
Account #:
Account #:
Email/Fax#:
Email/Fax#:
The applicant warrants that all preceding information is true and agrees to the following terms and conditions: • If credit is extended, payments will be made directly to EE Schenck Company in USD, in accordance with the agreed terms and in the event that I/we fail to do so, the account will bear interest at the rate of 1½% per month (18% per annum). • If payment is not made and the account is referred to a collection agency or legal action is necessary, applicant will pay all collection agency and legal fees necessary to collect our account. • Applicant further authorizes EE Schenck Company to access now and in the future credit information which may be obtained from 3rd party agencies, trade references and banking information, for the sole purpose of establishing, maintaining & reviewing my account with EE Schenck Company. • Applicant may be charged 15% fee for any canceled orders or returned goods. • Applicant will notify EE Schenck Company within 10 business days of any change in ownership. • The undersigned personally & individually, jointly & severally guaranty that the above customer will promptly pay all amounts due EE Schenck Company when due. EE Schenck Company also may proceed directly against the undersigned without first proceeding against the customer. EE Schenck may take any action with respect to the customer or the account without the consent of the undersigned, including but not limited to, increasing the credit line, modifying terms, extending the payment time and releasing the customer or any security for payment.
Signature:
Date:
Print Name:
CREDIT CARD INFORMATION
Complete the following section to use a Credit/Debit card for purchases. Address of Card Holder if Different than Above:
Card Number: Expiration Date: Name on Card:
Security Code:
Billing Address: City/State/Zip:
I agree to have funds or card limit available for orders and backorders. I understand that order amounts may be pre-authorized for the available to ship amount plus a potential freight estimate. EE Schenck may require a 50% deposit on initial orders. Dropship and Special Orders require a 100% deposit on at once deliveries and a 50% deposit on future deliveries.
Updated 042026